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ths Eroro�� <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />� <br />� <br />APPLICAiION FOR CONSTRI..:TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEH M�IL�DpRE% n CIiY 21P PMONE <br />�CK�'Y ,QrirN•r, � /$09 /'/NFNUIP3? LvRT 9�y��3 gsy-_�py[, <br />1fNANT MML�UDPESS CrtY ZIP PNONE <br />everen <br />e <br />ARCMRECfORpE51GNER M�4�ODRE55 CITv ZiP PMONE <br />�(i�Nt�JZ <br />OEREMLGONIiUCfON M��LAOORESS CITY 2iP PHONE �ILENSE• <br />Q W /Y �.�7Z <br />MECN�NIGLCANTMCTOR M�II�DOHE55 GITY ZIP PHOKE LICENSE• <br />O t�! Ne�� <br />PLUM&NOGONTR�CTOR MAIL�pDPESS QTY ZIP PHONE LiCENSE• <br />U w N��- <br />C�Ly/�BS OF WJRN <br />RLNEW ❑ ADDITION ❑ ALTEMTION ❑ REPSIR ❑ DEI.�QLITION ❑ WOODSTOYE/FRPL�NSERT ❑ B�ILDINGRELOC�TION <br />CONiMGT %iICE OF WJpK_ �' G� F i V <br />pEBC/JpIBENOPKIIND$OU:r ��OEMVOL <br />KC5�.DE•�ca �9 <br />PROPOSED USE OF BUILUINO <br />�GS I ��l u�J � <br />LEML DE9CNIPTiON OF PRIX'ENTY (SMOWN BELOW O 11TTI�CH FOl <br />:.OT� BLOCN OF �LGt�t! r ! <br />r� <br />PWMlINO <br />J <br />^ __ ...._. _ <br />1-u 2- <br />S F 't'� <br />R9REOUIRE�� "�i <br />er <br />3s <br />I HEREBV CERTIfY THAT I HAVE READ ANU EIUMINED THIS APPLICATION AND <br />KNOWTHESAMETOBETRUEANDCAPRECT.ALLPROVISIONSOFLAWSAND <br />ORDINANCES GOVEHNING THIS TfPE UF WORK WIIL BE COMPLETED WITH <br />WHETHER SPECIFIED 11EREINOR NOT. THEGRRNTINGOFA PERMRDOES NOT <br />PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEI TME PFi0VI510NS OF <br />ANV OTHER £T�TE OR LOCAL LAW RE6ULATING CONSTRUCTION OR TME PER- <br />FORMANCE JF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />TH�S PROPERTV TO PERFORM THE WOflK FOR WHICM APPLICATION IS MADE <br />AND I CAMPLV WIT!i THE STA7E CONTRACTORS LAW 1827 RCW AND <br />298200 WAG <br />SION�TOREOFCqNTRJ1CTOROHAUTHONRED�GENT ORE <br />MECM�NICAL <br />_ I .-.II) = UNITHEATERS-&T.U. <br />t ��`� CLOTHESDRVERS <br />� - VENTIUTION FAN <br />RANGEHOOD <br />� WATER HEATER <br />WOOD STOVE <br />MET4� FIREPLACEB CI <br />FIREr:.ACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E <br />S <br />❑ NO <br />n/ A <br />m <br />H.P. <br />flT.U. M EA <br />M <br />SUBTOTAL <br />PERMIT <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Z <br />��a <br />